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Table 2 Definitions of Quality of Care Indicators

From: Capitated versus fee-for-service reimbursement and quality of care for chronic disease: a US cross-sectional analysis

Quality Indicator

Numerator (visits by adults with)

Denominator (visits by adults with)

Quality Indicator Source

Strength of Recommendation/Level of Evidence

Hypertension

 Controlled Hypertension

Systolic BP < 140 and Diastolic BP < 90

or

Systolic BP < 130 and Diastolic BP < 80

Hypertension (physician-reported or ICD-9 code or receipt of antihypertensive)

JNC 7 [17] (2003) and JNC 8 [18] (2014)

Ea

Diabetes

 Controlled Diabetes

HbA1c < 7%

or

HbA1c < 8%

Diabetes (physician-reported or ICD-9 code or receipt of anti-diabetic agent)

ADA [23] (2012)

Bb

 ACEi/ARB use

ACEi/ARB listed or dispensed during visit

1) Diabetes (physician-reported or ICD-9 code or receipt of anti-diabetic agent)

and

2) Hypertension (physician-reported or ICD-9 code or receipt of antihypertensive)

ADA [23] (2012)

Cc

 Statin use

Statin listed or dispensed during visit

1) Diabetes (physician-reported or ICD-9 code or receipt of anti-diabetic agent)

and

2) Age 40–75

ACC/AHA [21]

(2013)

IAd

Chronic Kidney Disease

 Controlled Hypertension

Systolic BP < 130 and Diastolic BP < 80

or

Systolic BP < 140 and Diastolic BP < 90

1) CKD (physician-reported or ICD-9 code) and

2) Hypertension (physician-reported or ICD-9 code or receipt of antihypertensive)

JNC 7 [17] (2003) and ACC/AHA [25] (2017)

Ea

 Controlled Diabetes

HbA1c < 7%

or

HbA1c < 8%

1) CKD (physician-reported or ICD-9 code) and

2) Diabetes (physician-reported or ICD-9 code or receipt of anti-diabetic agent)

KDOQI [19] (2012)

ADA [23]

(2012)

1Ae

 ACEi/ARB use

ACEi/ARB listed or dispensed during visit

1) CKD (physician-reported or ICD-9 code) and

2) Hypertension (physician-reported or ICD-9 code or receipt of antihypertensive)

KDIGO CKD [20]

(2012)

1Bf, 2Dg

 Statin use

Statin listed or dispensed during visit

1) CKD (physician-reported or ICD-9 code) and

2) Age ≥ 50

KDIGO Lipid [22]

(2013)

1Ae, 1Bf

  1. CKD chronic kidney disease, ACEi Angiotensin converting enzyme inhibitor, ARB angiotensin receptor blocker, NSAID nonsteroidal anti-inflammatory drug, HbA1c Hemoglobin A1c, ICD International Classification of Diseases, JNC Joint National Committee, KDOQI Kidney Disease Outcomes Quality Initiative, ADA American Diabetes Association, KDIGO Kidney Disease Improving Global Outcomes
  2. a E - Expert Opinion
  3. b B - Supportive evidence from well-conducted cohort or case-control studies
  4. c C - Supportive evidence from poorly controlled or uncontrolled studies or conflicting evidence with the weight of evidence supporting the recommendation
  5. d IA – Procedure/treatment should be performed/administered, data derived from multiple randomized clinical trials or meta-analyses
  6. e 1A - Level 1 “We recommend,” High quality of evidence
  7. f 1B - Level 1 “We recommend,” Moderate quality of evidence
  8. g 2D - Level 2 “We suggest,” Very low quality of evidence